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Della Pietra A, Gómez Dabó L, Mikulenka P, Espinoza-Vinces C, Vuralli D, Baytekin I, Martelletti P, Giniatullin R. Mechanosensitive receptors in migraine: a systematic review. J Headache Pain 2024; 25:6. [PMID: 38221631 PMCID: PMC10788982 DOI: 10.1186/s10194-023-01710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/25/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Migraine is a debilitating neurological disorder with pain profile, suggesting exaggerated mechanosensation. Mechanosensitive receptors of different families, which specifically respond to various mechanical stimuli, have gathered increasing attention due to their potential role in migraine related nociception. Understanding these mechanisms is of principal importance for improved therapeutic strategies. This systematic review comprehensively examines the involvement of mechanosensitive mechanisms in migraine pain pathways. METHODS A systematic search across the Cochrane Library, Scopus, Web of Science, and Medline was conducted on 8th August 2023 for the period from 2000 to 2023, according to PRISMA guidelines. The review was constructed following a meticulous evaluation by two authors who independently applied rigorous inclusion criteria and quality assessments to the selected studies, upon which all authors collectively wrote the review. RESULTS We identified 36 relevant studies with our analysis. Additionally, 3 more studies were selected by literature search. The 39 papers included in this systematic review cover the role of the putative mechanosensitive Piezo and K2P, as well as ASICs, NMDA, and TRP family of channels in the migraine pain cascade. The outcome of the available knowledge, including mainly preclinical animal models of migraine and few clinical studies, underscores the intricate relationship between mechanosensitive receptors and migraine pain symptoms. The review presents the mechanisms of activation of mechanosensitive receptors that may be involved in the generation of nociceptive signals and migraine associated clinical symptoms. The gender differences of targeting these receptors as potential therapeutic interventions are also acknowledged as well as the challenges related to respective drug development. CONCLUSIONS Overall, this analysis identified key molecular players and uncovered significant gaps in our understanding of mechanotransduction in migraine. This review offers a foundation for filling these gaps and suggests novel therapeutic options for migraine treatments based on achievements in the emerging field of mechano-neurobiology.
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Affiliation(s)
- Adriana Della Pietra
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Laura Gómez Dabó
- Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Doga Vuralli
- Department of Neurology and Algology, Neuroscience and Neurotechnology Center of Excellence, Neuropsychiatry Center, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Isil Baytekin
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
| | - Rashid Giniatullin
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
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Mihalovic M, Mikulenka P, Línková H, Neuberg M, Štětkářová I, Peisker T, Lauer D, Tousek P. Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria. Eur Heart J Suppl 2023; 25:E3-E9. [PMID: 37234232 PMCID: PMC10206909 DOI: 10.1093/eurheartjsupp/suad104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan-Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.
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Affiliation(s)
- Michal Mihalovic
- Cardiocenter, Charles University-Third Faculty of Medicine, Ruská 87, 100 00 Prague, Czech Republic
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Ruská 87, 100 00 Prague, Czech Republic
| | - Hana Línková
- Cardiocenter, Charles University-Third Faculty of Medicine, Ruská 87, 100 00 Prague, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Partner of INTERCARDIS, Prosecká 852/66, 190 00 Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Ruská 87, 100 00 Prague, Czech Republic
| | - Tomáš Peisker
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Ruská 87, 100 00 Prague, Czech Republic
| | - David Lauer
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Ruská 87, 100 00 Prague, Czech Republic
| | - Petr Tousek
- Corresponding author. Fax: +420 267 163 388,
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Grangeon L, Lange KS, Waliszewska-Prosół M, Onan D, Marschollek K, Wiels W, Mikulenka P, Farham F, Gollion C, Ducros A. Genetics of migraine: where are we now? J Headache Pain 2023; 24:12. [PMID: 36800925 PMCID: PMC9940421 DOI: 10.1186/s10194-023-01547-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes code for proteins expressed in neurons, glial cells, or vessels, all of which increase susceptibility to cortical spreading depression. The study of monogenic migraines has shown that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk. The more than 180 known variants belong to several complex networks of "pro-migraine" molecular abnormalities, which are mainly neuronal or vascular. Genetics has also highlighted the importance of shared genetic factors between migraine and its major co-morbidities, including depression and high blood pressure. Further studies are still needed to map all of the susceptibility loci for migraine and then to understand how these genomic variants lead to migraine cell phenotypes.
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Affiliation(s)
- Lou Grangeon
- grid.41724.340000 0001 2296 5231Neurology Department, CHU de Rouen, Rouen, France
| | - Kristin Sophie Lange
- grid.6363.00000 0001 2218 4662Neurology Department, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin, Berlin, Germany
| | - Marta Waliszewska-Prosół
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Dilara Onan
- grid.14442.370000 0001 2342 7339Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Karol Marschollek
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Wietse Wiels
- grid.8767.e0000 0001 2290 8069Department of Neurology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Petr Mikulenka
- grid.412819.70000 0004 0611 1895Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Fatemeh Farham
- grid.411705.60000 0001 0166 0922Headache Department, Iranian Centre of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cédric Gollion
- grid.411175.70000 0001 1457 2980Neurology Department, CHU de Toulouse, Toulouse, France
| | - Anne Ducros
- Neurology Department, CHU de Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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Onofri A, Pensato U, Rosignoli C, Wells-Gatnik W, Stanyer E, Ornello R, Chen HZ, De Santis F, Torrente A, Mikulenka P, Monte G, Marschollek K, Waliszewska-Prosół M, Wiels W, Boucherie DM, Onan D, Farham F, Al-Hassany L, Sacco S. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. J Headache Pain 2023; 24:8. [PMID: 36782182 PMCID: PMC9926688 DOI: 10.1186/s10194-023-01541-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. MATERIAL AND METHODS We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. RESULTS Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. CONCLUSION We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.
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Affiliation(s)
- Agnese Onofri
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Umberto Pensato
- grid.417728.f0000 0004 1756 8807Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eHumanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Rosignoli
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - William Wells-Gatnik
- grid.7841.aDepartment of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Emily Stanyer
- grid.13097.3c0000 0001 2322 6764Wolfson Centre for Age Related Diseases, King’s College London, London, UK
| | - Raffaele Ornello
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Hui Zhou Chen
- grid.13097.3c0000 0001 2322 6764Wolfson Centre for Age Related Diseases, King’s College London, London, UK
| | - Federico De Santis
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Angelo Torrente
- grid.10776.370000 0004 1762 5517Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Petr Mikulenka
- grid.412819.70000 0004 0611 1895Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gabriele Monte
- grid.414125.70000 0001 0727 6809Department of Neuroscience, Neurology Unit, Bambino Gesù Children’s Hospital, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Karol Marschollek
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Waliszewska-Prosół
- grid.4495.c0000 0001 1090 049XDepartment of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Wietse Wiels
- grid.8767.e0000 0001 2290 8069Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deirdre M. Boucherie
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dilara Onan
- grid.14442.370000 0001 2342 7339Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Fatemeh Farham
- grid.411705.60000 0001 0166 0922Department of Headache, Iranian Center of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Linda Al-Hassany
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.
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Mihalovic M, Mikulenka P, Linkova H, Stetkarova I, Peisker T, Lauer D, Tousek P. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is associated with cardiac injury and stroke severity in patients after acute ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients after acute stroke frequently show signs of myocardial injury. The pathophysiology and impact on patient's outcome are not fully understood. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is cytokine known to be associated with cardiovascular events.
Purpose
We aimed to assess TRAIL level dynamic changes in patients after acute ischemic stroke and its relations to cardiac injury, stroke severity and impact on short-term outcome.
Methods
Between August 2020 and August 2021, 104 consecutive patients after acute ischemic stroke (AIS) were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24- and 48-hours later to determine levels of Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitive Troponin I (hs-cTnI). Twelve lead ECG at admission, 24-, 48-hours later and at the release of the patients were obtained. Patients underwent echocardiographic examination within first 5 days of hospitalization, if eligible. National Institutes of Health Stroke Scale (NIHSS) at admission and modified Rankin Scale (mRS) at 90 days following the patient's discharge from the hospital were performed. Chi-square, Fishers exact test and regression analysis were performed to detect differences between variables using SPSS statistics. Results were considered statistically significant at a significance level of p<0.05.
Results
We found significant negative association between TRAIL and NT-proBNP at admission (p=0.039), after 24 (p=0.043) and 48 hours (p=0.023) of hospitalization. There was significant negative association between TRAIL and hs-cTnI at admission (p=0.04). Moreover, we found significant negative association between TRAIL and stroke severity evaluated by NIHSS at admission (p=0.044) and negative association with severe disability or death evaluated by mRS at 90 days both after 24 (p=0.0022) and 48 hours (p=0.044) of hospitalization. In ECG analysis, lower TRAIL levels were associated with the occurrence of premature ventricular extrasystoles (p=0.043), and there was a near statistically significant association with prolonged QTc interval (p=0.07). Two patients presented with new left ventricular regional wall motion abnormality.
Conclusions
Lower TRAIL levels are associated with laboratory markers of cardiac injury, stroke severity and unfavorable functional outcome in patients after acute ischemic stroke.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Charles University Research Program Cooperatio – Cardiovascular sciences
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Affiliation(s)
- M Mihalovic
- Faculty Hospital Kralovske Vinohrady, Cardiocenter, 3rd Faculty of Medicine, Charles University , Prague , Czechia
| | - P Mikulenka
- Faculty Hospital Kralovske Vinohrady, Department of Neurology - Third Faculty of Medicine , Prague , Czechia
| | - H Linkova
- Faculty Hospital Kralovske Vinohrady, Cardiocenter, 3rd Faculty of Medicine, Charles University , Prague , Czechia
| | - I Stetkarova
- Faculty Hospital Kralovske Vinohrady, Department of Neurology - Third Faculty of Medicine , Prague , Czechia
| | - T Peisker
- Faculty Hospital Kralovske Vinohrady, Department of Neurology - Third Faculty of Medicine , Prague , Czechia
| | - D Lauer
- Faculty Hospital Kralovske Vinohrady, Department of Neurology - Third Faculty of Medicine , Prague , Czechia
| | - P Tousek
- Faculty Hospital Kralovske Vinohrady, Cardiocenter, 3rd Faculty of Medicine, Charles University , Prague , Czechia
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Mihalovic M, Mikulenka P, Línková H, Neuberg M, Štětkářová I, Peisker T, Lauer D, Tousek P. Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) in Patients after Acute Stroke: Relation to Stroke Severity, Myocardial Injury, and Impact on Prognosis. J Clin Med 2022; 11:jcm11092552. [PMID: 35566677 PMCID: PMC9103556 DOI: 10.3390/jcm11092552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is known to be associated with poor prognosis after cardiovascular events. We aimed to assess the dynamic changes in TRAIL levels and the relation of TRAIL level to stroke severity, its impact on the short-term outcomes, and its association with markers of cardiac injury in patients after acute stroke. Methods: Between August 2020 and August 2021, 120 consecutive patients, 104 after acute ischemic stroke (AIS), 76 receiving reperfusion therapy, and 16 patients after intracerebral hemorrhage (ICH) were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 h later, and 48 h later to determine the plasma level of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitive Troponin I (hs-TnI). Twelve-lead ECGs were obtained at the time of admission, 24 h later, 48 h later, and at the release of the patients. Evaluations were performed using the National Institutes of Health Stroke Scale (NIHSS) at the time of admission and using the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital. Results: We observed a connection between lower TRAIL levels and stroke severity evaluated using the NIHSS (p = 0.044) on the first day. Lower TRAIL showed an association with severe disability and death as evaluated using the mRS at 90 days, both after 24 (p = 0.0022) and 48 h (p = 0.044) of hospitalization. Moreover, we observed an association between lower TRAIL and NT-proBNP elevation at the time of admission (p = 0.039), after 24 (p = 0.043), and after 48 h (p = 0.023) of hospitalization. In the ECG analysis, lower TRAIL levels were associated with the occurrence of premature ventricular extrasystoles (p = 0.043), and there was an association with prolonged QTc interval (p = 0.052). Conclusions: The results show that lower TRAIL is associated with stroke severity, unfavorable functional outcome, and short-term mortality in patients after acute ischemic stroke. Moreover, we described the association with markers of cardiac injury and ECG changes.
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Affiliation(s)
- Michal Mihalovic
- Cardiocenter, Third Faculty of Medicine, Charles University, 100 34 Prague, Czech Republic
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 100 34 Prague, Czech Republic
| | - Hana Línková
- Cardiocenter, Third Faculty of Medicine, Charles University, 100 34 Prague, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Partner of INTERCARDIS Project, 190 00 Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 100 34 Prague, Czech Republic
| | - Tomáš Peisker
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 100 34 Prague, Czech Republic
| | - David Lauer
- Department of Neurology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 100 34 Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University, 100 34 Prague, Czech Republic
- Correspondence:
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Castaldo M, Waliszewska-Prosół M, Koutsokera M, Robotti M, Straburzyński M, Apostolakopoulou L, Capizzi M, Çibuku O, Ambat FDF, Frattale I, Gadzhieva Z, Gallo E, Gryglas-Dworak A, Halili G, Jusupova A, Koperskaya Y, Leheste AR, Manzo ML, Marcinnò A, Marino A, Mikulenka P, Ong BE, Polat B, Popovic Z, Rivera-Mancilla E, Roceanu AM, Rollo E, Romozzi M, Ruscitto C, Scotto di Clemente F, Strauss S, Taranta V, Terhart M, Tychenko I, Vigneri S, Misiak B, Martelletti P, Raggi A. Headache onset after vaccination against SARS-CoV-2: a systematic literature review and meta-analysis. J Headache Pain 2022; 23:41. [PMID: 35361131 PMCID: PMC8969402 DOI: 10.1186/s10194-022-01400-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods We searched PubMed and EMBASE covering the period between January 1st 2020 and August 6th, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. “traditional” vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset. Results Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18–27%) of subjects after the first dose of vaccine and in 29% (95% CI 23–35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10–12% of cases. No differences were detected across different vaccines or by mRNA-based vs. “traditional” ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown. Conclusions Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40–60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01400-4.
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8
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Peisker T, Vaško P, Mikulenka P, Lauer D, Kožnar B, Sulženko J, Roháč F, Kučera D, Girsa D, Kremeňová K, Widimský P, Štětkářová I. OUP accepted manuscript. Eur Heart J Suppl 2022; 24:B48-B52. [PMID: 35370500 PMCID: PMC8971735 DOI: 10.1093/eurheartjsupp/suac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The recanalization effect of large-vessel occlusion (LVO) in anterior circulation is well documented but only some patients benefit from endovascular treatment. We analysed clinical and radiological factors determining clinical outcome after successful mechanical intervention. We included 146 patients from the Prague 16 study enrolled from September 2012 to December 2020, who had initial CT/CTA examination and achieved good recanalization status after mechanical intervention (TICI 2b-3). One hundred and six (73%) patients achieved a good clinical outcome (modified Rankin Scale 0–2 in 3 months). It was associated with age, leptomeningeal collaterals (LC), onset to intervention time, ASPECTS, initial NIHSS, and leukoaraiosis (LA) in univariate analysis. The regression model identified good collateral status [odds ratio (OR) 5.00, 95% confidence interval (CI) 1.91–13.08], late thrombectomy (OR 0.24, 95% CI 0.09–0.65), LA (OR 0.44, 95% CI 0.19–1.00), ASPECTS (OR 1.45, 95% CI 1.08–1.95), and NIHSS score (OR 0.86, 95% CI 0.78–0.95) as independent outcome determinants. In the late thrombectomy subgroup, 14 out of 33 patients (42%) achieved a favourable clinical outcome, none of whom with poor collateral status. The presence of LC and absence of LA predicts a good outcome in acute stroke patients after successful recanalization of LVO in anterior circulation. Late thrombectomy was associated with higher rate of unfavourable clinical outcome. Nevertheless, collateral status in this subgroup was validated as a reliable selection criterion.
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Affiliation(s)
- Tomáš Peisker
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
- Corresponding author. Tel: +420267162380,
| | - Peter Vaško
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - David Lauer
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Boris Kožnar
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Jakub Sulženko
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Filip Roháč
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Dušan Kučera
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - David Girsa
- Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Karin Kremeňová
- Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Petr Widimský
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Praha, Prague, Czech Republic
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Tomek A, Petra R, Paulasová Schwabová J, Olšerová A, Škorňa M, Nevšímalová M, Šimůnek L, Herzig R, Fafejtová Š, Mikulenka P, Táboříková A, Neumann J, Brzezny R, Sobolová H, Bartoník J, Václavík D, Vachová M, Bechyně K, Havlíková H, Prax T, Šaňák D, Černíková I, Ondečková I, Procházka P, Rajner J, Škoda M, Novák J, Škoda O, Bar M, Mikulík R, Dostálová G, Linhart A. Nationwide screening for Fabry disease in unselected stroke patients. PLoS One 2021; 16:e0260601. [PMID: 34905550 PMCID: PMC8670679 DOI: 10.1371/journal.pone.0260601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by disease-associated variants in the alpha-galactosidase A gene (GLA). FD is a known cause of stroke in younger patients. There are limited data on prevalence of FD and stroke risk in unselected stroke patients. Methods A prospective nationwide study including 35 (78%) of all 45 stroke centers and all consecutive stroke patients admitted during three months. Clinical data were collected in the RES-Q database. FD was diagnosed using dried blood spots in a stepwise manner: in males—enzymatic activity, globotriaosylsphingosine (lyso-Gb3) quantification, if positive followed by GLA gene sequencing; and in females GLA sequencing followed by lyso-Gb3. Results 986 consecutive patients (54% men, mean age 70 years) were included. Observed stroke type was ischemic 79%, transient ischemic attack (TIA) 14%, intracerebral hemorrhage (ICH) 7%, subarachnoid hemorrhage 1% and cerebral venous thrombosis 0.1%. Two (0.2%, 95% CI 0.02–0.7) patients had a pathogenic variant associated with the classical FD phenotype (c.1235_1236delCT and p.G325S). Another fourteen (1.4%, 95% CI 0.08–2.4) patients had a variant of GLA gene considered benign (9 with p.D313Y, one p.A143T, one p.R118C, one p.V199A, one p.R30K and one p.R38G). The index stroke in two carriers of disease-associated variant was ischemic lacunar. In 14 carriers of GLA gene variants 11 strokes were ischemic, two TIA, and one ICH. Patients with positive as compared to negative GLA gene screening were younger (mean 60±SD, min, max, vs 70±SD, min, max, P = 0.02), otherwise there were no differences in other baseline variables. Conclusions The prevalence of FD in unselected adult patients with acute stroke is 0.2%. Both patients who had a pathogenic GLA gene variant were younger than 50 years. Our results support FD screening in patients that had a stroke event before 50 years of age.
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Affiliation(s)
- Aleš Tomek
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
- * E-mail:
| | - Reková Petra
- First Faculty of Medicine, Department of Neurology and Center of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslava Paulasová Schwabová
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Anna Olšerová
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miroslav Škorňa
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslava Nevšímalová
- Department of Neurology, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Libor Šimůnek
- Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Department of Neurology, Hradec Králové, Czech Republic
| | - Roman Herzig
- Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Department of Neurology, Hradec Králové, Czech Republic
| | - Štěpánka Fafejtová
- Department of Neurology, Regional Hospital Karlovy Vary, Karlovy Vary, Czech Republic
| | - Petr Mikulenka
- 3 Medical Faculty, Department of Neurology Neurology Dpt., Charles University and University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Alena Táboříková
- Department of Neurology Neurology Dpt., Krajská zdravotní, a.s.—Hospital Chomutov, Chomutov, Czech Republic
| | - Jiří Neumann
- Department of Neurology Neurology Dpt., Krajská zdravotní, a.s.—Hospital Chomutov, Chomutov, Czech Republic
| | - Richard Brzezny
- Department of Neurology Neurology Dpt., Regional Hospital Kladno, Kladno, Czech Republic
| | - Helena Sobolová
- Department of Neurology Neurology Dpt., Hospital Třinec, Třinec, Czech Republic
| | - Jan Bartoník
- Department of Neurology Neurology Dpt., Regional Hospital of Tomáš Baťa, Zlín, Czech Republic
| | - Daniel Václavík
- Department of Neurology, AGEL Research and Training Institute, Ostrava Vítkovice Hospital, Ostrava, Czech Republic
| | - Marta Vachová
- Department of Neurology, Krajská zdravotní, a.s.—Hospital Teplice, Teplice, Czech Republic
| | - Karel Bechyně
- Department of Neurology, Hospital Písek, Písek, Czech Republic
| | - Hana Havlíková
- Department of Neurology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Tomáš Prax
- Department of Neurology, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Daniel Šaňák
- Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Irena Černíková
- Department of Neurology, Regional Hospital Kolín, Kolín, Czech Republic
| | - Iva Ondečková
- Department of Neurology, Krajská zdravotní, a.s.—Hospital Děčín, Děčín, Czech Republic
| | - Petr Procházka
- Department of Neurology, Regional Hospital Uherské Hradiště, Uherské Hradiště, Czech Republic
| | - Jan Rajner
- Department of Neurology, Municipal Hospital Ostrava, Ostrava, Czech Republic
| | - Miroslav Škoda
- Department of Neurology, Regional Hospital Náchod, Náchod, Czech Republic
| | - Jan Novák
- Department of Neurology, Regional Hospital Česká Lípa, Česká Lípa, Czech Republic
| | - Ondřej Škoda
- Department of Neurology, Hospital Jihlava, Jihlava, Czech Republic
| | - Michal Bar
- D epartment of Neurology, University Hospital Ostrava and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center and Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Gabriela Dostálová
- First Faculty of Medicine, 2nd Department of Medicine–Department of Cardiovascular Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Aleš Linhart
- First Faculty of Medicine, 2nd Department of Medicine–Department of Cardiovascular Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Mikulenka P, Stetkarova I. Hemichorea in ketotic hyperglycemia with hyperdense striatum mimicking hemorrhagic transformation in a patient using apixaban. Neuro Endocrinol Lett 2020; 41:162-165. [PMID: 33307650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Diabetic striatopathy is a rare condition characterized by unilateral hemichorea and/or hemiballismus in the settings of uncontrolled nonketotic diabetes mellitus. Imaging studies usually reveal striatal abnormality - subtle hyperdensity on CT and T1 hyperintensity on MRI. The resolution of clinical symptoms is prompt when optimal glycaemic control is achieved. CASE REPORT We present the case of a 90-year-old male who came to our attention for acute involuntary choreiform movements of his left-sided extremities lasting two-weeks. Apart from that neurological examination was unremarkable. His medical history included hypertension, atrial fibrillation, previous stroke with no residual disability and poorly controlled type 2 diabetes mellitus on metformin treatment. There was no history of movement disorders or exposure to neuroleptics. His glucose level on admission was 512.6 mg/dL, glycated hemoglobin was 14%. CT scan of the head demonstrated an abnormally increased intensity within the right striatum. Treatment consisted of symptomatic treatment of chorea and improvement of blood glucose control. Tiapride was started with a dose of 100 mg 4 times a day. The patient was initiated on intensive insulin therapy which included insulin glargine 10 units every evening and 12 units of insulin glulisine 3 times a day with meals. Abnormal movements resolved after normoglycemia was achieved approximately 7 days after admission. Though striatal hyperdensity was still present at follow-up CT scan after 10 days, it was less pronounced. CONCLUSION Diabetic striatopathy is a rare but treatable disorder and should be considered in patients with poorly controlled diabetes who present with hemichorea.
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Affiliation(s)
- Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Mikulenka P, Stetkarova I, Vasko P, Peisker T. Left ventricle cardiac myxoma as a cause of ischaemic stroke in young patient treated by mechanical thrombectomy. Neuro Endocrinol Lett 2020; 41:109-112. [PMID: 33201646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Cardiac myxoma is a rare cause of cardioembolic stroke, especially in young patients. Acute treatment includes intravenous thrombolysis or acute thrombectomy via mechanical recanalisation. We present a case of a young 21-year-old woman with no symptoms of dyspnoea who suddenly developed expressive aphasia and right-sided hemiparesis due to a thrombus in the left middle cerebral artery followed by the left anterior cerebral artery. She underwent acute mechanical thrombectomy with improvement of the neurological status. Bedside ultrasonography detected a suspected myxoma, which was further confirmed by a CT scan as a myxoma in the left cardiac ventricle. The patient underwent successful surgery. We stress on the importance of echocardiographic examination in young patients after ischaemic stroke and multidisciplinary team cooperation in the treatment management of such patients.
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Affiliation(s)
- Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vasko
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Benemei S, Labastida-Ramírez A, Abramova E, Brunelli N, Caronna E, Diana P, Gapeshin R, Hofacker MD, Maestrini I, Pías EM, Mikulenka P, Tikhonova O, Martelletti P, MaassenVanDenBrink A. Persistent post-traumatic headache: a migrainous loop or not? The preclinical evidence. J Headache Pain 2020; 21:90. [PMID: 32664898 PMCID: PMC7362418 DOI: 10.1186/s10194-020-01135-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background According to the International Classification of Headache Disorders 3, post-traumatic headache (PTH) attributed to traumatic brain injury (TBI) is a secondary headache reported to have developed within 7 days from head injury, regaining consciousness following the head injury, or discontinuation of medication(s) impairing the ability to sense or report headache following the head injury. It is one of the most common secondary headache disorders, and it is defined as persistent when it lasts more than 3 months. Main body Currently, due to the high prevalence of this disorder, several preclinical studies have been conducted using different animal models of mild TBI to reproduce conditions that engender PTH. Despite representing a simplification of a complex disorder and displaying different limitations concerning the human condition, animal models are still a mainstay to study in vivo the mechanisms of PTH and have provided valuable insight into the pathophysiology and possible treatment strategies. Different models reproduce different types of trauma and have been ideated in order to ensure maximal proximity to the human condition and optimal experimental reproducibility. Conclusion At present, despite its high prevalence, PTH is not entirely understood, and the differential contribution of pathophysiological mechanisms, also observed in other conditions like migraine, has to be clarified. Although facing limitations, animal models are needed to improve understanding of PTH. The knowledge of currently available models is necessary to all researchers who want to investigate PTH and contribute to unravel its mechanisms.
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Affiliation(s)
- Silvia Benemei
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Ekaterina Abramova
- Pain Clinic Unit, Department of Anesthesiology, Pirogov City Clinical Hospital, Moscow, Russia
| | | | - Edoardo Caronna
- Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Paola Diana
- Child Neuropsychiatry Unit, Department of PROMISE, University of Palermo, Palermo, Italy
| | - Roman Gapeshin
- Department of Neurology and Manual Medicine, Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Maxi Dana Hofacker
- Department of Neurology, Headache Centre, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Enrique Martínez Pías
- Neurology Department, Hospital Clínico Universitario of Valladolid, Valladolid, Spain
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Olga Tikhonova
- Department of neurology, Kazaryan Clinic of Epileptology and Neurology, Moscow, Russia
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
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Mikulenka P, Peisker T, Vasko P, Stetkarova I. Diagnosis of cerebral venous thrombosis: a single centre experience. Neuro Endocrinol Lett 2019; 39:473-479. [PMID: 30796798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cerebral venous thrombosis is a serious cerebrovascular disease. Due to the variability of clinical symptoms and the scarcity of occurrence, this diagnosis is often delayed. The aim of the study was to describe the risk factors, the initial findings and the imaging methods that lead to the diagnosis. METHODS We included 34 patients treated for cerebral venous thrombosis in the years 2004-2016. We retrospectively analyzed demographic data, initial clinical symptoms, baseline D-dimer levels, risk factors, time to diagnosis, and MR findings. RESULTS The most common initial clinical symptom was headache (28 patients, 82.4%). Focal neurological symptoms or signs of encephalopathy developed in 22 patients (64.7%). In 26 patients, we identified at least one risk factor in their history. In women of childbearing potential, 68% of patients (15/22) were taking hormonal contraceptives; in six people the diagnosis was immediately preceded by inflammation. In all patients, the diagnosis was confirmed by MR venography. Positive hereditary thrombophilic conditions were identified in 68% and acquired in 8% of 25 examined patients. In 22 cases, baseline D-dimer levels were examined and found to be increased in 86% of them. The mean time from the first onset of symptoms to diagnosis was 6.9 days. CONCLUSION Cerebral venous thrombosis has a variable clinical course and the diagnosis is determined a relatively long time after the onset of symptoms. Atypical headache in the patient's history and a set of risk factors are the key findings for indication of imaging methods and confirmation of the diagnosis.
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Affiliation(s)
- Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vasko
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Baca V, Horak Z, Mikulenka P, Dzupa V. Comparison of an inhomogeneous orthotropic and isotropic material models used for FE analyses. Med Eng Phys 2008; 30:924-30. [DOI: 10.1016/j.medengphy.2007.12.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
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